Does Race Affect How Alzheimer’s Is Diagnosed
MONDAY, Jan. 7, 2019 — Alzheimer’s disease may be twice as common in black Americans as in whites, and scientists don’t really know why.
But new research uncovers a clue that suggests that diagnosing the brain-robbing disease may not be the same for these two populations.
The study found that black people typically have lower levels of the brain protein tau. And because rising levels of tau are considered a sign of Alzheimer’s, blacks may not meet the same threshold as whites for when Alzheimer’s starts.
“If we only study Alzheimer’s in Caucasians, we’ll only learn about Alzheimer’s in Caucasians,” said researcher Dr. John Morris. He is a professor of neurology at Washington University School of Medicine in St. Louis.
“If we want to understand all the ways the disease can develop in people, we need to include people from all groups. Without a complete understanding of the illness, we’re not going to be able to develop therapies that work for all people,” Morris said.
For the study, Morris and his colleagues analyzed data from more than 1,200 people, of whom 14 percent were black. The participants averaged 71 years of age.
Two-thirds of the participants had no signs of memory loss or confusion, and the remaining one-third had very mild or mild Alzheimer’s, according to the report.
This means that assuming tau levels to be the same among different populations may result in an inaccurate diagnosis, he explained.
Is Alzheimers Diagnosed With A Blood Test
The other biomarker test, uses either a blood sample or, more commonly, a cerebral spinal fluid sample. The CSF sample is obtained via a spinal tap.
We look for markers of Alzheimers disease in the blood and the spinal fluid samples. These are pieces of the plaques and tangles that might be circulating in the blood or spinal fluid.
Therefore, the patient can have a thinking and memory test, and then typically the physician will add on additional tests. One could be a PET scan of the brain and the other one could be a test of either the blood or cerebral spinal fluid.
Diagnosing Alzheimers disease is a process. And its typically a combination of these three approaches: Cognitive Testing, PET biomarkers and fluid either blood or spinal biomarkers.
In all cases, personal results are compared to norms. The person is compared to other healthy people in the population that are approximately just like them. Neurologists look at the levels of all of the things that they are measuring to determine if they think its Alzheimers disease.
And thats how a diagnosis goes.
Are Childhood Alzheimers And Childhood Dementia The Same
Childhood Alzheimers and childhood dementia might sound like they describe the same condition. But just like Alzheimers and dementia are two separate conditions in adults, childhood dementia is a separate condition from childhood Alzheimers.
Childhood dementia is caused by a group of conditions called neuronal ceroid lipofuscinosis . When a child has NCL, proteins, and lipids build up in their body and lead to decline.
Like childhood Alzheimers, NCL is fatal. Children often die when theyre between 10 and 15 years old.
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Early Warning Signs And Diagnosis
Alzheimers Disease can be caught in the early stageswhen the best treatments are availableby watching for telltale warning signs. If you recognize the warning signs in yourself or a loved one, make an appointment to see your physician right away. Brain imaging technology can diagnose Alzheimers early, improving the opportunities for symptom management.
Reviewing Health History And Mental State
If you are experiencing troubling changes in memory, behavior, or thinking abilities, make an appointment to discuss your concerns with a doctor, even if it seems scary.
Primary-care physicians often oversee the diagnostic process but may refer patients to a specialist such as a neurologist, neuropsychologist, geriatrician, or geriatric psychiatrist.
An Alzheimers assessment will include the following:
- Medical and family history Your history includes past and present illnesses, any medications you take, and any conditions affecting other members of your family.
- Mood assessment The doctor will look for signs of depression or other mental-health disorders that can cause memory problems or other dementia-like symptoms.
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What Causes Childhood Alzheimers
Both types of childhood Alzheimers are caused by genetics. The diseases are recessive, so both parents need to be a carrier of the gene for a child to inherit the condition.
Children born to parents who both carry the genes that cause childhood Alzheimers have a 1 in 4 chance of developing the condition.
Parents pass down genes that are unable to produce the correct protein cells need to work. When the lysosomes of cells cant work as they should, the body cant produce the other things it needs to function properly.
Eventually, fats, cholesterol, or sugars will build up in the cells of an affected child. This will lead to a decline in brain and organ function.
What Type Of Tests Might Be Done
A consultation with a doctor will also include the following tests:
- Physical exam The doctor will ask about your diet and alcohol consumption, check your blood pressure and temperature, take your pulse, listen to your heart and lungs, and may perform other relevant parts of a physical exam to assess your overall health.
- Diagnostic tests Screening tests and blood and urine analysis can rule out health problems with symptoms mirroring those of Alzheimers, such as depression, untreated sleep apnea, delirium, medication side effects, thyroid problems, certain vitamin deficiencies, and excessive alcohol consumption.
- Neurological exam By testing reflexes, eye movement, speech, sensation, coordination, muscle tone, and strength, a doctor looks for evidence of stroke or other conditions that may cause Alzheimers-like symptoms.
- Mental status tests A health professional may ask a series of questions to assess your basic cognitive skills. You may be asked to remember a short list of words, follow a set of simple instructions, do simple calculations, or draw a clockface with the hands pointing to a specific time. Some doctors may use computer-based tests.
- Brain imaging The doctor might order a CT or MRI scan to look for tumors, evidence of stroke or severe brain injury, a buildup of fluid, or other issues that create symptoms resembling those of Alzheimers disease but that require different treatment.
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Information For Your Doctor
Itâs a good idea to put together the following for your first appointment:
- A list of symptoms — include everything youâre feeling, even if you donât think it could be related to dementia
- Any sources of major stress or recent life changes
- A list of all medications you take, including vitamins and supplements, and the dosage
- A list of any questions you have
Mortality Due To Any Cause
All-cause mortality rates increase with age. In 20132014, for Canadians with dementia, the rate was 75.5 deaths per 1,000 population in the 6569 years age group, and it reached 207.2 deaths per 1,000 population in the 85 years and older age group. However, as the overall mortality among Canadians with and without dementia increases later in life, mortality rates between the two groups tend to converge. In other words, the all-cause mortality rate ratios decrease with age. In 20132014, the rate ratio was 7.6 in the 6569 years age group, and it decreased to 2.9 in the 85 years and older age group.
Since 20032004, all-cause mortality rates have decreased among all Canadians. Among Canadians with dementia however, rates decreased at a slower pace. This is illustrated by the increasing rate ratios between 20032004 and 20132014. In 20132014, the age-standardized all-cause mortality rate was about four times higher among seniors with dementia compared to those without .
Figure 2: Age-standardized all-cause mortality rates and rate ratios among Canadians aged 65 years and older with and without diagnosed dementia, including Alzheimer’s disease, Canada, 20032004 to 20132014
Text description: Figure 2Figure 2: Age-standardized all-cause mortality rates and rate ratios among Canadians aged 65 years and older with and without diagnosed dementia, including Alzheimer’s disease, Canada, 20032004 to 20132014
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Start The Conversation Regarding Memory Care Options
Memory care will play a role at some point, and the quality of this care and its ability to improve the quality of life for your loved one is 100% related to how soon s/he transitions into the right community. This will probably require multiple conversations as you weigh the pros and cons of various options, and tour facilities and communities.
While the idea of staying home is preferred by many, caregiving for a middle- to late-stage Alzheimers patient is a full-time job.
Unfortunately, contrary to the original plan, many spouses or close family members realize too late that they arent capable of providing the level of care required, 24/7. That results in a very traumatic transition into memory care, assisted living or nursing home care and it may mean having to give up your first-choice if they dont have space when you finally make a decision.
What To Do If Someone In Your Family Is Diagnosed With Alzheimer’s
Contact the Alzheimer’s Association . Find out about resources available to help you and your family. State and county agencies may also be able to help.
Plan for the future. This includes legally designating someone to make health care and financial decisions for the affected person when he or she can’t.
Investigate long-term care options. Nursing care is expensive, and finding a good place can take time. Start early.
Take care of physical health. People with dementia who live a healthy lifestyle tend to progress more slowly to the later stages.
Steer away from genetic testing. Even if you have the APOE Alzheimer’s risk gene, it usually doesn’t mean you will develop dementia later in life.
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Stage : Moderately Severe Dementia
When the patient begins to forget the names of their children, spouse, or primary caregivers, they are most likely entering stage 6 of dementia and will need full time care. In the sixth stage, patients are generally unaware of their surroundings, cannot recall recent events, and have skewed memories of their personal past. Caregivers and loved ones should watch for:
- Delusional behavior
How Is Alzheimer’s Disease Diagnosed
Doctors use several methods and tools to help determine if a person with thinking or memory problems has Alzheimers disease. To diagnose Alzheimers, doctors may:
- Ask the person experiencing symptoms, as well as a family member or friend, questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality.
- Administer a psychiatric evaluation to determine if depression or another mental health condition is causing or contributing to a person’s symptoms.
- Conduct tests of memory, problem solving, attention, counting, and language.
- Order blood, urine, and other standard medical tests that can help identify other possible causes of the problem.
- Perform brain scans, such as computed tomography , magnetic resonance imaging , or positron emission tomography , to support an Alzheimers diagnosis or rule out other possible causes for symptoms.
Doctors may want to repeat these tests to help best determine how the persons memory and other cognitive functions are changing over time. The tests can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinsons disease, sleep disturbances, side effects of medication, an infection, or another type of dementia. Some of these conditions may be treatable and possibly reversible.
People with memory problems should return to the doctor every six to 12 months.
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What To Do If A Doctor Jumps To A Diagnosis In A Single Visit
Unfortunately, some doctors do jump quickly to a dementia diagnosis in only one visit. Even worse, they dont properly document what led to their decision.
If this happens, you may want to seek a second opinion from a doctor who is willing and able to do more thorough evaluation and testing.
Yes, there is a chance that your older adults symptoms could mean that they have dementia.
Thats why an accurate diagnosis is essential for proper treatment.
How Alzheimers Disease Is Diagnosed
Diagnosing Alzheimers disease can involve several tests and scans. There is no simple or reliable way to diagnose this condition.
In fact, Alzheimers disease can be definitively diagnosed only after death by performing an autopsy and studying the brain’s tissues microscopically. As of now, healthcare providers can only determine whether Alzheimers is a possibility or probability.
Your healthcare provider will probably review your symptoms and medical history and then conduct a physical and neurological exam. They may also perform a series of tests to help determine whether you have symptoms like confusion, memory loss, or difficulty with reasoning or concentration.
You may undergo imaging scans and lab tests to help rule out other conditions. Your doctor may also suggest a spinal tap procedure to check for indicators of Alzheimers disease.
In addition to reviewing your symptoms and medical history, your healthcare provider may also ask close family members about your behavior and mental state.
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How To Get A Diagnosis Of Dementia
How to get a diagnosis of dementia is one of the most common questions our Admiral Nurses are asked, so we have broken this question down into the key points we think you need to know.
If youre concerned that you, or someone you know, is showing signs of dementia, its important to see a GP.
There are many different conditions that can mimic the early signs of dementia including: infections, delirium, vitamin deficiency, depression, anxiety, diabetes. These conditions are treatable, so it is important to visit a GP for tests to identify and manage these conditions. Once these conditions have been ruled out and there are still concerns about the ongoing changes then the GP may refer to the specialist memory assessment team for further tests.
An early diagnosis of dementia can help the person and their family to understand what form of dementia they have, why the changes they are experiencing are happening, and what they can do to manage them. It also enables the person and their family to have conversations about how to live as well as possible with the diagnosis and to plan for the future.
The symptoms of dementia include changes in:
- short-term memory
- communication, comprehension and word finding
- ability to perform everyday tasks
- personality, mood, behaviour or social functioning
In an initial appointment, the GP should ask the person about:
Women Might Be At Higher Risk
Age is the major risk factor for Alzheimers disease, and women on average live longer than men.
However, longevity alone does not fully explain why two-thirds of Alzheimers patients are women. Even after taking into account the difference in longevity, some studies have suggested that women are still at a higher risk.
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Tour Your Options As Soon As You Can
Its helpful for prospective residents to tour memory care options themselves so they have some autonomy in the decision. However, we understand that this can be scary and nerve-wracking for many and that some simply refuse to do it all together.
If your loved one is resistant to touring options with you, we recommend inviting a close family member or friend to accompany and support you. You might find starting the process solo bringing back information and ideas will motivate your spouse or loved one to accompany you the next time.
Read,Questions to Ask When Touring Memory Care Facilities, so you get the information and details you need to make a good decision.
Benefits Of Getting A Diagnosis
Early detection and diagnosis of Alzheimers disease or another dementia is critical to ensuring proper support, care and treatment of the illness. It is also important because it allows people with the disease and their families to make key financial and care decisions while they are still functioning at the highest possible level.
The diagnosis of dementia often comes as a complete shock. However, many people feel relieved once they have identified the source of their worries after a diagnosis has been made.
Getting an early diagnosis will help you to move forward and gain more control over your life by taking the necessary steps to live better with the disease. Receiving an early diagnosis allows a person to:
- Understand the symptoms they are experiencing, and the changes that they can expect
- Gain access to information, resources and support
- Benefit from and explore treatment options
- Plan for the future
- Develop and engage support networks
- Maximize their quality of life.
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Set Up A Medical Plan And Start Thinking About Caregiving
Do you know how often you or your loved one needs to have doctors appointments, or what treatments they should be on? Is there a spouse, partner, friend, adult child or professional caregiver in the picture who can help them manage their health, pick up prescriptions and keep them safe? You or your loved one may not need full time or even part time caregiving right now, but now is a good time to start thinking about it rather than waiting for an emergency.
Why Early Detection Can Be Difficult
Alzheimers disease usually is not diagnosed in the early stages, even in people who visit their primary care doctors with memory complaints.
- People and their families generally underreport the symptoms.
- They may confuse them with normal signs of aging.
- The symptoms may emerge so gradually that the person affected doesnt recognize them.
- The person may be aware of some symptoms but go to great lengths to conceal them.
Recognizing symptoms early is crucial because medication to control symptoms is most effective in the early stages of the disease and early diagnosis allows the individual and his or her family members to plan for the future. If you or a loved one is experiencing any of the following symptoms, contact a physician.
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